Medicare
Therapeutic Shoe Program – A program under Medicare offering free foot-care for
diabetics.The coverage includes a specialized shoe program to help
prevent complications for people with diabetes and those with foot problems.Under the program patients are entitled to (annually)
one pair of customized shoes, two sets of inserts, and a fitting by a
podiatrist or shoe specialist.Patients
can order molded or a depth shoe.

Visit our Heath Insurance page to find out what your state laws require health insurance to cover for diabetes care, a list of assistance programs, and Medicare information.

Amputation
Fact Sheet - This fact sheet discusses the common sources of amputation in
the workplace, steps employers can take to prevent them and the OSHA standards
that cover amputation hazards.

Diabetic
Neuropathies: The Nerve Damage of Diabetes – Information about the causes,
symptoms, and significant types of neuropathy. Includes information about
diagnosis and treatment, and the findings of the Diabetic Control and
Complication Trial (DCCT) in relation to neuropathy.

If you have diabetes you need to pay special attention to your feet.Certain complications with diabetes may cause
loss of sensation from nerve damage (neuropathy) and circulation throughout the body,
including the feet.Reduced sensation
can interfere with the body’s injury warning system:pain.Even small cuts, blisters, and abrasions can go unnoticed (because they don't hurt) and can become infected
due to poor circulation.

Diabetics
in general, have a tendency towards easier infection, and infections with
diabetes are slower and harder to overcome – especially when blood glucose is
not under tight control. Hyperglycemia (high blood glucose levels) reduce the body's ability to fight infection normally. Keeping your blood glucose in range will not only help prevent damage and infection, but will help your body overcome an infection.

Infections
can ulcerate, fail to respond to treatment, and eventually all, or a portion of
the foot, may need to be surgically removed (amputated).If the infection persists even after
amputation, it may even be necessary to remove part of the leg from below the
knee in order to halt the deadly progression, which unaddressed, can lead to
death.

(Diabetes Care, November 2004;27:2636-2641) reported alarming statistics
for the rate of amputation among the diabetic population in Barbados.However, from the data, we are reminded that
an ounce of prevention is worth a pound of cure.For example, the study indicated that simply not wearing shoes tripled the
risk of diabetes-related, lower-extremity amputation among Barbados residents and risk of
amputation was quadrupled in the same population for those wearing “fashion”
footwear, as well as for female walkers wearing sneakers into town.It would seem obvious that good footwear plays an important role in preventing foot ulcerations which can lead to further complications including
amputation.

Other
risk factors for amputation (indicated in the report) include the following:

For
those who examined their feet daily, a remarkable 80% risk reduction was
reported.

Diabetes-Related
Amputation Statistics

Each year, approximately
80,000-84,000 nontraumatic, lower-limb amputations are performed due to
complications from diabetes (United
States).

Diabetes-related
amputations account for more than 60% of all nontraumatic lower-limb
amputations (United States).

Partial
foot amputation is successful in about 75% of diabetes-related amputations; 25%
fail and require amputation of the leg from below the knee (United States).

A predictor of those who undergo surgery (partial amputation) and will
not require further amputation is how well blood glucose is controlled prior to
surgery.Those with A1c levels at 7 or
below stand a far greater chance for successful outcome.Post surgery target-range blood glucose
levels are critical to avoid further amputation.

How Problems Can Occur

Chronic
high blood glucose levels can restrict blood flow and diminish circulation to the lower
limbs, especially the feet.The problem
is worse for older a persons and those who have had diabetes longer periods of time (true for both
type 1 or type 2 diabetes). Perhaps one of the most important prediction variables, and one that can be avoided with proper daily attention to blood glucose levels, is whether or not the person has been managing their
diabetes effectively.

Poor
circulation makes it harder to treat infections and ulcers, made harder
still when blood glucose levels are high.Neuropathy, (damage to nerves) can make it hard to detect problems early
due to diminished, or even the total loss of sensation.Persons with neuropathy can lose all feeling in an area and suffer
severe damage to tissue and never even feel it.(One physician stated “neuropathy can leave feet and lower legs so numb
patients could walk around with a nail under their foot for a day and not
realize it."

Early
detection and treatment is crucial to saving limbs but unfortunately, by the
time most patients seek treatment there is already gangrenous tissue
surrounding ulcerations and the limb cannot be saved.

Amputation Procedures and Rate of
Success

Below-the-knee
surgical amputation of the damaged leg used to be standard procedure.In the past ten years a new procedure called
transmetatarsal amputation (TMA) is more commonly performed.In this procedure only part of the front of
the foot is removed.TMA is not
successful in all patients and further, more aggressive amputation (below the
knee) is still required.In the United States,
many doctors are still inclined to perform the older, more invasive
surgery.If you are facing amputation,
be sure to ask if you are a candidate for TMA.

Success
rate of surgical TMA for persons with HbA1c blood glucose levels of 7% or lower
is highly successful.

Preventive Care for Diabetes
Foot-Related Complications

Since most
problems for diabetics begin with small sores on the skin like scrapes and
blisters it is important to visually inspect your feet every single day.Other steps you can take to ensure healthy
feet include lifestyle changes and observation:

Quit smoking, which can cause
or aggravate circulatory problems

Check blood glucose often, and
stay in target range as much as possible

Be aware that heating pads or
electric blankets can burn skin, especially when neuropathy is present.

The most
frequent reason for hospitalization in persons with diabetes is due to problems
with their feet.But many of these
problems, including amputation and hospitalization, could be prevented through
simple preventive foot care.

Depression

The rate of
depression among diabetics with ulcerations parallels that of those who have
already undergone amputation.Part of
the reason may be that ulceration often is an impending sign of the need for
amputation.Counseling for both those
with ulcerations showing signs of depression, and for those having undergone
amputation is often advised.